Abstract P236: Impact of Acculturation and Health Literacy on Prevalent Fasting Glycemia Among Latinos: Results From the Boston Area Community Health (BACH) Survey
Background Acculturation is the process by which immigrant groups adopt the cultural practices and values of the host country. We hypothesized higher acculturation is associated with higher prevalence of hyperglycemia and that lower health literacy levels mediate this association.
Methods The BACH survey is a community-based random- sample cohort of 3,155 individuals interviewed between 2010-2012. Impaired fasting glucose (IFG) was defined as a FG of 100-124 and diabetes as a FG > 125 mg/dL or self-report of diabetes. Acculturation was measured using the validated Bidimensional Acculturation Rating Scale for Hispanics and modeled as a bivariate (high vs. low) variable. Health literacy was measured with the S-TOFHLA and modeled into three categories (inadequate, minimal, adequate). We examined the bivariate associations of acculturation with demographic and clinical variables. In addition, we used multivariate linear and logistic regression, adjusting models predicting diabetes or continuous FG for age, gender, socioeconomic status, health literacy, BMI, cholesterol level, presence of coronary disease and the use of antihyperglycemic medications. Interaction analyses were performed between acculturation and literacy to assess their association with FG level.
Results Of 817 Latinos in BACH with a determined diabetes status, the mean age was 52 yrs, 88% were foreign born and 69% reported > 20 years of living in the US. Most had yearly incomes of < $40K/yr (69%), 33% reported at least a high school education, 4 % had no insurance and 97% reported having a usual place of medical care. Most participants (64%) had a low acculturation status. Highly acculturated (including bicultural) Latinos had higher rates of IFG (44% vs. 38%) but lower rates of diabetes (21% vs. 31%)) than those with low acculturation (overall p=0.09). Less acculturated Latinos had a high rate of inadequate and minimal literacy (61%) while most highly acculturated Latinos had adequate literacy (69%) (p<0.001). Participants with adequate health literacy had slightly higher prevalence of IFG (42% vs. 39%) but lower prevalence of diabetes (17% vs. 35%) compared to those with inadequate and minimal literacy combined (overall p=0.002). In adjusted analyses, high acculturation was associated with a 4.30 mg/dL higher FG compared to low acculturation (p=0.08). There was no significant interaction effect between acculturation and literacy on FG level (p=0.08).
Conclusion Among a primarily foreign born Latino population with a long residence period in the US, higher levels of acculturation were not associated with a higher FG level. Health literacy level does not modify this association. Future diabetes prevention in Latinos will need to further explore other contributing factors.
- © 2013 by American Heart Association, Inc.